Exercise may offer drug-free migraine prevention

NEW YORK (Reuters Health) - Regular aerobic exercise worked just as well as relaxation therapy or the antiepileptic drug topiramate in preventing migraine headaches in a Swedish trial.

"This non-pharmacological approach may therefore be an option for the prophylactic treatment of migraine in patients who do not benefit from or do not want daily medication," wrote Dr. Emma Varkey and her colleagues from the Institute of Neuroscience and Physiology, University of Gothenburg, in the journal Cephalalgia.

Varkey's team randomly assigned their subjects to one of three regimens for three months: aerobic exercise on a stationary bike (40 minutes three times per week), a standard form of relaxation therapy or daily topiramate.

Previous studies have shown that relaxation therapy and topiramate are both effective for migraine prevention, the investigators note in their paper.

The 91 women in the trial were all from a single headache clinic in Sweden. They were between 18 and 65 years old, had neurologist-diagnosed migraine, with or without aura, and got headaches two to eight times per month.

All three treatments reduced the frequency of some women's migraine attacks by as much as three quarters, although the average reduction was more modest.

In an email to Reuters Health, Varkey admitted that she was a bit surprised by the small between-group differences. "Topiramate is a drug of first choice which has shown great effects in studies. It was a bit surprising and very interesting that the change in number of migraine attacks was almost similar in all three groups," she said.

"The only parameter where topiramate was better compared with exercise and relaxation was the reduction of pain intensity," Varkey added. "On the other hand, the non-pharmacological options were free from adverse events and the exercise group increased oxygen uptake, which is very positive."

None of the women in the relaxation group or exercise group reported side effects, but eight women (33%) in the topiramate group did and three withdrew from the study as a result. The most commonly reported side effects of the drug included numbness or tingling, fatigue, depressed mood, vertigo and constipation.

Finding that exercise is not inferior to topiramate as a prophylactic measure is "of great value," the researchers note in their report, because patients often seek non-pharmacological options for migraine.

"From a wider health-based perspective, it should be stressed that patients with migraine are less physically active than the general population, and that exercise has positive effects in terms of general well-being and the prevention of disease," they added.

"Additional and larger studies are, of course, needed to verify our results and to gain evidence for exercise as migraine treatment, but our results are hopeful," Varkey told Reuters Health.